Chau, Kin Fan. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (leaves 106-119). / Abstract also in Chinese. / Abstract --- p.II / 摘要 --- p.VI / Acknowledgements --- p.IX / List of figures --- p.X / List of Abbreviations --- p.XII / Table of Contents --- p.XV / Chapter Chapter 1: --- Introduction / Chapter 1.1 --- Incidence and etiology of hepatocellular carcinoma (HCC) --- p.1 / Chapter 1.2 --- Structure of Hepatitis B Virus (HBV) --- p.2 / Chapter 1.3 --- Hepatitis B X protein (HBx) and HCC --- p.5 / Chapter 1.4 --- HBx and Apoptosis --- p.8 / Chapter 1.5 --- The role of Bcl-2 family in apoptosis and cell survival --- p.10 / Chapter 1.6 --- "Bid, the BH3-domain only protein" --- p.14 / Chapter 1.7 --- Dual Functions of Bid --- p.16 / Chapter 1.8 --- The relationship between Bid and HBx --- p.19 / Chapter 1.9 --- Hypoxia and HCC --- p.21 / Chapter 1.10 --- Hypoxia and HBx --- p.25 / Chapter 1.11 --- Hypoxia and Bid --- p.28 / Chapter 1.12 --- Aim of study --- p.29 / Chapter Chapter 2: --- Methods and materials / Chapter 2.1 --- Confirmation of the culture of the stable cell lines --- p.30 / Chapter 2.2 --- Doxorubicin treatment to the cell lines --- p.34 / Chapter 2.3 --- Culture of the cell lines under hypoxic conditions --- p.35 / Chapter 2.4 --- Protein sample preparations --- p.37 / Chapter 2.5 --- Determination of protein samples --- p.38 / Chapter 2.6 --- Sodium dodecyl sulfate 226}0ؤ polyacrylamide gel electrophoresis (SDS- PAGE) --- p.39 / Chapter 2.7 --- Transfer of protein to nitrocellulose membranes --- p.39 / Chapter 2.8 --- Western blot analysis of proteins --- p.41 / Chapter 2.8.1. --- Antibodies --- p.41 / Chapter 2.8.2. --- Determination of expression profiles of desired proteins by immunoblotting --- p.45 / Chapter 2.9 --- "Measurement of cell viability by MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay" --- p.46 / Chapter 2.10 --- Determination of cell proliferation by BrdU proliferation assay --- p.47 / Chapter 2.11 --- Detection of apoptosis of the cell lines by TUNEL (Terminal deoxynucleotidyl transferase mediated dUTP Nick End Labeling) --- p.50 / Chapter 2.12 --- Determination of the involvement of p38 MAPK in the generation of truncated Bid by p38 MAPK inhibitor SB203580 --- p.52 / Chapter Chapter 3: --- Results / Chapter 3.1 --- Confirmation of plasmids and the stable cell lines --- p.53 / Chapter 3.2 --- Morphology and the basic parameters of the cells with full-length HBx or mutant HBx --- p.53 / Chapter 3.3 --- Cell viability under doxorubicin treatment with or without hypoxia --- p.59 / Chapter 3.4 --- Determination of cell proliferation under stress --- p.70 / Chapter 3.5 --- Expression profiles of various proteins in the stable cell lines under doxorubicin treatment with or without hypoxia --- p.74 / Chapter 3.5.1. --- Verification of hypoxia --- p.74 / Chapter 3.5.2. --- Pro-apoptotic proteins --- p.74 / Chapter 3.5.3. --- Anti-apoptotic proteins --- p.74 / Chapter 3.6 --- Determination of apoptosis of various cell lines under stress --- p.82 / Chapter 3.7 --- "p38 MAPK, but not Akt, was activated by doxorubicin" --- p.87 / Chapter 3.8 --- The p38 MAPK inhibitor SB203580 could attenuate the cleavage of Bid --- p.89 / Chapter Chapter 4: --- Discussion --- p.92 / Chapter Chapter 5: --- Conclusion and future prospective --- p.103 / Chapter Chapter 6: --- References --- p.106

Na prática hemoterápica em todo mundo, a triagem e o diagnóstico da infecção pelo HCV continua sendo um desafio. Desta forma, considerando as variáveis genéticas do vírus da Hepatite C e as variáveis populacionais de cada região, o conhecimento mais profundo da realidade da epidemiologia molecular do vírus da Hepatite C na população de doadores de sangue em regiões específicas se torna cada vez mais imprescindível. Desta forma, este estudo visou realizar a caracterização sorológica e molecular da infecção pelo Vírus da Hepatite C (HCV) em doadores de sangue do Estado do Amazonas a fim de subsidiar conhecimentos para interpretação dos diferentes perfis laboratoriais e clínicos, além de contribuir para o conhecimento das rotas de transmissão e da epidemiologia da infecção do Amazonas. Foram estudados 154 doadores de sangue do Estado do Amazonas com sorologia repetidamente reativa para anti-HCV. Foram realizados testes sorológicos por ELISA e Imunoblot, testes de detecção de RNA viral plasmático por Nested PCR, determinação da carga viral e genotipagem do vírus por sequenciamento. O estudo foi realizado no período de setembro de 2005 a abril de 2007 quando o índice de descarte por anti-HCV reativo foi de 0,37%. Foi observado que 50% dos casos de Imunoblot indeterminado apresentaram positividade no Nested PCR indicando a presença de RNA plasmático. A carga viral baixa foi um fator limitante para a determinação do genótipo viral pelo método de sequenciamento de algumas amostras. A freqüência de casos presumidos de clearance viral plasmático na amostra estudada foi de 18,8%. O genótipo mais prevalente do HCV nos doadores do Estado do Amazonas foi o genótipo 1 (87,5%) seguido do genótipo 3 (12,5%). Considerando as nuances da história natural da Hepatite C e os diversos momentos clínicos que os doadores possam se encontrar devem ser adotadas mudanças de condutas do acompanhamento dos doadores sororeativos para anti-HCV no banco de sangue do Amazonas e no fluxograma de diagnóstico da infecção. / The screening and diagnostic of HCV infection continue to be a challenge on the hemotherapic practice because the unique characteristics of each population and the molecular variability of the virus. The aim of this study was to characterize the serologic and molecular profile of 154 anti-HCV+ Amazon blood donors from the Amazon Hematology and Hemoterapy Foundation. Screening for anti HCV antibody was performed using ELISA and recombinant Imunoblot assay. Seropositive samples were assessed further with Nested PCR, viral load and genotyping techniques. In the study period, 2005-2007 the anti-HCV discard rate was 0,37%. We observed that 50% of the indeterminate Immunoblot cases showed HCV RNA presence in plasma by Nested PCR. The most prevalent genotype between subjects of this study was genotype 1 (87,5%), followed by genotype 3 (12,5%). The presumed plasma clearance frequency was 18,8%. The low viral load was a determinant critical factor to the genotype determination in some samples. Considering the different stages of the HCV natural infection different conducts may be adopted with inclusion of molecular testes as the first option for confirmation to the follow up of the positive anti-HCV blood donors in the Amazon blood bank and in the algorithm of the infection diagnostic, saving resources and providing a better counseling for the reactive donors.

Le virus de l’hépatite C (VHC) est une des principales causes d’hépatite chronique. La protéine F du VHC est codée par un cadre de lecture alternatif du gène de la capside, Core. La protéine F a été découverte après que l’on ait associé Core à plusieurs des fonctions pathogènes du VHC. Nous proposons donc que certaines fonctions biologiques et pathogènes attribuées à la protéine Core résultent de l’activité de la protéine F. Nous avons choisi de développer trois lignées de poissons zébrés (Danio rerio) qui expriment différentes versions de la protéine F afin d’étudier les effets de la protéine F et leur incidence dans la pathogenèse du VHC. Deux versions de la séquence codant pour la protéine F (AF11 et AUG26) et une version mutante du gène core (CoremutI) ont été introduites sur les vecteurs d’un système d’expression répressible spécifique au foie. Ces vecteurs ont été co-injectés dans des embryons unicellulaires de poissons zébrés pour générer les poissons fondateurs des lignées transgéniques. 19, 21 et 36 poissons ont été choisis comme fondateurs pour les lignées AF11, AUG26 et CoremutI respectivement. De ce nombre, 9, 11 et 11 poissons ont atteint la maturité, dans l’ordre pour les mêmes lignées, et seront croisés pour donner naissance à des lignées transgéniques stables. Les résultats de ces expériences nous permettront de mieux cerner les propriétés biologiques de la protéine F et de définir son rôle dans la pathogenèse du VHC. / Hepatitis C virus (HCV) is a major cause of liver steatosis, fibrosis and hepatocellular carcinoma. HCV F protein is expressed from an alternative reading frame within the Core sequence. F protein was discovered after many of the pathogenic determinants of HCV had been associated with the effects of Core. Hence, we propose that a part of the functions attributed to Core result from the activity of the F protein. We produced and selected 19, 21 and 36 transgenic zebrafish (Danio rerio) to give rise to 3 independent lines expressing different versions of the F protein. Of these founders, 9, 11 and 11 were raised to maturity and will be bred to generate stable transgenic lines. Characterizing the phenotype of these transgenic fish will help determine the precise role of the F protein in the pathogenesis of hepatitis C.

Dans cette étude, la bile d’un porc canadien naturellement infecté par une souche du virus de l’hépatite E (VHE) a été utilisée afin d’inoculer deux groupes de porcelets. Dans l’étude précoce (E), 4 porcelets âgés de 4 semaines et exempts de pathogènes spécifiques (SPF), ont été suivis jusqu’à 14 jours post-inoculation (pi). Dans l’étude tardive (L), 9 porcelets ont été suivis à chaque semaine jusqu’à l’abattage, soit 120 jours pi. À la nécropsie, la présence du VHE a été évaluée dans différents organes à 7, 14 et 120 jours pi. Des porcelets témoins (E=2 et L=3) ont été inoculés par de la bile exempte de VHE. Le virus a persisté chez certains animaux jusqu’à 84 à 105 jours pi dans le sérum malgré la présence d’anticorps IgG anti-VHE dans le sang, suggérant une virémie prolongée. L’excrétion virale dans les fèces s’est étalée également sur une période de 105 jours pi chez certains animaux. De plus, la détection de l’ARN viral dans les organes évalués s’est révélée presque nulle à l’âge d’abattage à l’exception de quelques vésicules biliaires, alors qu’on retrouvait l’ARN viral dans plusieurs organes à 7 et 14 jours pi. Pour évaluer la distribution du VHE chez les porcs commerciaux du Québec, un échantillonnage de porcs de trois abattoirs a été réalisé. Environ 100 échantillons de sang, fèces, foies et bile provenant des mêmes animaux en processus d’abattage ont été prélevés dans chacun des abattoirs, sur des porcs destinés à la consommation humaine. La détection de l’ARN viral et des anticorps du VHE a été réalisée à l’aide d’une RT-PCR nichée et d’un test ELISA adapté pour déceler les anticorps porcins anti-VHE. Chez les porcs d’abattoir, 12,9 % des échantillons de bile contenaient de l’ARN viral du VHE, alors que la détection virale était moindre dans les autres organes. Une séroprévalence en IgG de 26,0 % a été obtenue pour les sérums porcins analysés. Une analyse phylogénétique des différentes souches isolées pendant l’étude a démontré qu’elles sont du génotype 3. Ces données indiquent une exposition potentielle des travailleurs de l’industrie porcine au VHE porcin, notamment par les fèces, le sang et les organes et également pour les consommateurs par le biais des foies. / In this study, a strain of porcine hepatitis E virus (HEV) isolated from the bile of a naturally-infected Canadian pig was used to inoculate two groups of piglets. In the early-phase experiment (E), 4 one month-old piglets, specific pathogen free (SPF), were monitored for 14 days. In the late-phase experiment (L) 9 piglets were monitored up to slaughter (120 days post-inoculation (pi)). Controls piglets (E=2 and L=3) were inoculated with free HEV bile. The presence of HEV was monitored routinely in their blood and feces. At necropsy, viral occurence was evaluated in organs at 7, 14 and 120 days pi. Interestingly, HEV was found to persist in the serum of some animals up to 84-105 days pi, despite the presence of IgG HEV antibodies in their blood. Fecal shedding was detected until 105 days pi for a portion of pigs. In organs, HEV RNA was detected in low amount of gallbladders at killing time, while it was detected in a large number of organs at 7 and 14 days pi. To assess the distribution of HEV in commercial finishing pig in Quebec, a sampling was realised in pigs from three slaughterhouses from Quebec. Approximately a hundred samples of feces, blood, bile and liver were collected in each slaughterhouse, on pigs intended for human consumption. A sample of each type was collected on each of the chosen pigs. Detection of HEV RNA was carried out using a nested RT-PCR on each sample and a human ELISA test was adapted for the detection of swine antibodies against HEV in swine serum samples. For pigs at slaughter, 12,9 % of the bile samples were positive to HEV RNA and a seroprevalence of IgG of 26,0 % was detected in swine. A phylogenetic analysis demonstrated that all strains of the study were in the genotype 3. All results demonstrate that porcine industry workers are potentially exposed to swine HEV by feces, blood and organs.

L'hépatite C pose un problème de santé publique majeur, dans la mesure où le risque de développer une infection chronique est relativement élevé (40 à 60%) et où la résistance au traitement de choix - l’interféron alpha pégylé et la ribavirine - touche près de la moitié des patients. Cette persistence virale repose avant tout sur de puissantes stratégies d’évasion du système immunitaire inné de l’hôte par le virus. Dans ce projet, nous nous sommes intéressés à la caractérisation de la réponse antivirale dans des hépatocytes primaires humains normaux et chroniquement infectés avec le VHC, un domaine encore largement inconnu dû à la difficulté d’obtenir ce type de matériel primaire. Nous avons étudié la fonctionnalité de deux voies majeures de détection des pathogènes viraux suite à l’exposition d’hépatocytes primaires humains à de l’ARNdb intracellulaire, via le récepteur et adaptateur RIG-I/MDA5-CARDIF, et extracellulaire via TLR3-TRIF, mimant ainsi les étapes précoces de la détection d’un virus par la cellule hôte. Nous avons établi par RT-PCR quantitatif et analyse transcriptomique par microarray, que ces deux voies de stimulation sont fonctionnelles dans des hépatocytes primaires normaux et que leur activation entraîne à la fois l’expression de gènes antiviraux communs (ISG56, ISG15, CXCL10, …) mais aussi spécifiques avec les gènes IL28A, IL28B et IL29 qui sont une signature de l’activation de la voie de détection de l’ARNdb intracellulaire. La protéine virale NS3/4A joue un rôle majeur à la fois dans le clivage de la polyprotéine virale initiale, mais aussi en interférant avec les cascades de signalisation engagées suite à la détection par la cellule hôte de l’ARN du VHC. Plus particulièrement, nous avons démontré que l’expression ectopique de NS3/4A dans des hépatocytes primaires humains normaux entraîne une diminution significative de l’induction des gènes antiviraux dûe au clivage de CARDIF au cours de l’activation de la voie de signalisation médiée par RIG-I. Nous avons également démontré que l’expression de la NS3/4A entraîne des modifications de l’expression de gènes-clé impliqués dans la régulation de l’apoptose et du programme de mort cellulaire, en particulier lorsque la voie TLR3 est induite. L’ensemble de ces effets sont abolis en présence de BILN2061, inhibiteur spécifique de NS3/4A. Malgré les stratégies de subversion de l’immunité innée par le VHC, nous avons démontré l’induction significative de plusieurs ISGs et chemokines dans des hepatocytes primaires provenant de patients chroniquement infectés avec le VHC, sans toutefois détecter d’interférons de type I, III ou certains gènes antiviraux précoces comme CCL5. Ces observations, concomitantes avec une diminution de l’expression de CARDIF et une correlation inverse entre les niveaux d’ARNm des ISGs et l’ARN viral révèlent une réponse antivirale partielle dûe à des mécanismes interférents sous-jacents. Cette réponse antivirale détectable mais inefficace est à mettre en lien avec l’échec du traitement classique PEG-IFN-ribavirine chez la moitié des patients traités, mais aussi en lien avec l’inflammation chronique et les dommages hépatiques qui mènent ultimement au développement d’une fibrose puis d’une cirrhose chez une grande proportion de patients chroniquement infectés. / Hepatitis C infection is a worldwide health problem since the risk to develop a persistent infection is relatively elevated (40 to 60%) and nearly half of the infected patients do not respond to the classical anti-HCV therapy based on a combination of PEG-IFNα and ribavirin. Viral persistence is based on powerful evasion strategies of the host’s innate immune system. In our study, we characterized antiviral response in primary human normal and chronically HCV-infected hepatocytes, a cutting-edge in our field due to the difficulty to isolate this particular cell type. In order to better define the antiviral response in freshly isolated human primary hepatocytes, we stimulated these cells with extracellular and intracellular dsRNA to trigger TLR3/TRIF and RIG-I-MDA5/CARDIF-mediated antiviral signaling pathways. By using qRT-PCR and microarray analysis, we report that both detection pathways are functional in normal human hepatocytes, their activation leading to the expression of both common (IFIT1, OASL, ISG15 and CXCL10) and specific genes (IL28A, IL28B and IL29), these last ones being a signature of the intracellular dsRNA-mediated pathway. HCV NS3/4A plays a key role in the viral polyprotein processing and upon viral RNA detection by interfering with the host’s antiviral signalling cascades. We report that major antiviral genes induction following activation of RIG-I mediated pathway are severely impaired in ectopically NS3/4A expressing normal hepatocytes due to CARDIF cleavage, but can be restored by specific NS3/4A inhibitor BILN2061. Our microarray analysis also revealed a role for NS3/4A following TRL3-mediated pathway activation on regulation of apoptosis and programmed cell death, which could be linked to strategies for the virus to persist in its host. Despite HCV strategies to circumvent the host’s immune defense system, we observed significant upregulation of ISGs and chemokines in liver biopsies and corresponding isolated hepatocytes from chronically HCV-infected patients. However, no type I and III interferon, neither key-antiviral genes (e.g., CCL5) were detected, underlying an ongoing –but inefficient- antiviral response unable to eradicate the virus. Moreover, we obtained significant inverse correlations between ISGs mRNAs and viral RNA in addition to CARDIF decrease, clearly unravelling efficient viral interfering strategies in a context of chronic HCV infection. This sustained -albeit incomplete- hepatic innate immune response is certainly associated to the failure of the classical IFN-based therapy in half of the infected patients and to the chronic inflammation causing liver damages and eventually leading to hepatocarcinoma which is often observed at late stage of the disease.

Hepatito B virusas (HBV) yra plačiai paplitęs žmogaus patogenas, bet iki šiol mažai ištirta jo šerdies baltymo (HBc), o ypač natūraliai aptinkamų mutantinių formų įtaka viruso dauginimuisi ir patogeniškumui. Šiame darbe mielių dviejų hibridų metodu atrinkti žmogaus kepenų baltymai, sąveikaujantys su laukinio tipo baltymu bei mutantais HBc1 ir HBc2. Su visomis tirtomis HBc atmainomis stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai GIPC1 ir GIPC2. Detaliau tiriant šias sąveikas nustatyta, kad HBc baltymo C-galas sąveikauja su GIPC1 ir GIPC2 baltymų PDZ domenais. HBc baltymo C-gale aptiktas PDZ domenų atpažįstamos sekos motyvas ir parodyta, kad šios sekos pokyčiai įtakoja HBc sąveiką su GIPC1 ir GIPC2. Vien su mutantais HBc1 ir HBc2 stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai FLJ20850 ir IKK (NEMO). Anksčiau netyrinėto nežinomos funkcijos žmogaus baltymo FLJ20850 raiška ir geno struktūra apibūdinta naudojantis bioinformatinėmis duomenų bazėmis. Detaliau tiriant mutantų sąveikas su FLJ20850 ir IKK buvo nustatytos baltymų sritys, apsprendžiančios tarpusavio sąveiką. IKK baltymas reguliuoja transkripcijos veiksnio NF-κB aktyvumą, todėl buvo tiriama ir mutanto HBc1 įtaka NF-κB aktyvumui žmogaus ląstelėse. Aptiktos baltymų sąveikos gali padėti geriau suprasti HBV dauginimosi ciklą bei patogeniškumą ir tapti naujų antivirusinių vaistų taikiniais. / Hepatitis B virus (HBV) is a major human pathogen, but up to now little is known about its core protein (HBc) interactions with host proteins. The role of mutated HBc proteins in enhanced pathogenicity of mutant viruses is also unclear. In this work, the yeast two-hybrid system was employed to find human proteins interacting with HBV core mutants HBc1 and HBc2, as well as with the wild-type core protein. All HBc variants strongly and specifically interacted with human proteins GIPC1 and GIPC2. Common protein interaction domain PDZ in both GIPC1 and GIPC2 was identified as the region interacting with the C-end of HBc. A putative PDZ-interacting motif was identified at the C-end of the HBc protein, and variation of this sequence influenced determined interactions. Human proteins FLJ20850 and IKKγ (NEMO) strongly and specifically interacted with mutants HBc1 and HBc2 only. Gene structure and expression FLJ20850 protein, which was never before described in scientific literature, were analyzed bioinformatically. Detailed analysis of interacting protein pairs revealed regions, responsible for discovered interactions. IKKγ is known as an important regulator of transcription factor NF-kB, therefore HBc1 influence on NF-kB activity in human cells was evaluated experimentally. Determined protein interactions potentially add to understanding of HBV replication and pathogenicity and could serve as targets for developing of new antivirals.

Hepatitis B virus (HBV) is a major human pathogen, but up to now little is known about its core protein (HBc) interactions with host proteins. The role of mutated HBc proteins in enhanced pathogenicity of mutant viruses is also unclear. In this work, the yeast two-hybrid system was employed to find human proteins interacting with HBV core mutants HBc1 and HBc2, as well as with the wild-type core protein. All HBc variants strongly and specifically interacted with human proteins GIPC1 and GIPC2. Common protein interaction domain PDZ in both GIPC1 and GIPC2 was identified as the region interacting with the C-end of HBc. A putative PDZ-interacting motif was identified at the C-end of the HBc protein, and variation of this sequence influenced determined interactions. Human proteins FLJ20850 and IKKγ (NEMO) strongly and specifically interacted with mutants HBc1 and HBc2 only. Gene structure and expression FLJ20850 protein, which was never before described in scientific literature, were analyzed bioinformatically. Detailed analysis of interacting protein pairs revealed regions, responsible for discovered interactions. IKKγ is known as an important regulator of transcription factor NF-kB, therefore HBc1 influence on NF-kB activity in human cells was evaluated experimentally. Determined protein interactions potentially add to understanding of HBV replication and pathogenicity and could serve as targets for developing of new antivirals. / Hepatito B virusas (HBV) yra plačiai paplitęs žmogaus patogenas, bet iki šiol mažai ištirta jo šerdies baltymo (HBc), o ypač natūraliai aptinkamų mutantinių formų įtaka viruso dauginimuisi ir patogeniškumui. Šiame darbe mielių dviejų hibridų metodu atrinkti žmogaus kepenų baltymai, sąveikaujantys su laukinio tipo baltymu bei mutantais HBc1 ir HBc2. Su visomis tirtomis HBc atmainomis stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai GIPC1 ir GIPC2. Detaliau tiriant šias sąveikas nustatyta, kad HBc baltymo C-galas sąveikauja su GIPC1 ir GIPC2 baltymų PDZ domenais. HBc baltymo C-gale aptiktas PDZ domenų atpažįstamos sekos motyvas ir parodyta, kad šios sekos pokyčiai įtakoja HBc sąveiką su GIPC1 ir GIPC2. Vien su mutantais HBc1 ir HBc2 stipriausiai ir specifiškiausiai sąveikavo žmogaus baltymai FLJ20850 ir IKK (NEMO). Anksčiau netyrinėto nežinomos funkcijos žmogaus baltymo FLJ20850 raiška ir geno struktūra apibūdinta naudojantis bioinformatinėmis duomenų bazėmis. Detaliau tiriant mutantų sąveikas su FLJ20850 ir IKK buvo nustatytos baltymų sritys, apsprendžiančios tarpusavio sąveiką. IKK baltymas reguliuoja transkripcijos veiksnio NF-κB aktyvumą, todėl buvo tiriama ir mutanto HBc1 įtaka NF-κB aktyvumui žmogaus ląstelėse. Aptiktos baltymų sąveikos gali padėti geriau suprasti HBV dauginimosi ciklą bei patogeniškumą ir tapti naujų antivirusinių vaistų taikiniais.

Hepatitis C virus (HCV) is a single-stranded plus-sense RNA virus that is transmitted by blood-to-blood contact, and infects the human liver. HCV has a unique dependence on the liver-specific microRNA miR-122, where miR-122 binds the 5´ un-translated region of the viral RNA at two tandem sites and increases viral RNA abundance. The mechanisms of augmentation are not yet fully understood, but the interaction is known to stabilize the viral RNA, increase translation from the viral internal ribosomal entry site (IRES), and result in increased viral yield. In an attempt to create a small animal model for HCV, we added miR-122 to mouse cell lines previously thought non-permissive to HCV, which rendered these cells permissive to the virus, additionally showing that miR-122 is one of the major determinants of HCV hepatotropism. We found that some wild-type and knockout mouse cell lines – NCoA6 and PKR knockout embryonic fibroblasts – could be rendered permissive to transient HCV sub-genomic, but not full-length, RNA replication upon addition of miR-122, and that other wild-type and knockout cell lines cannot be rendered permissive to HCV replication by addition of miR-122. These knockout cell lines demonstrated varying permissiveness phenotypes between passages and isolates and eventually completely lost permissiveness, and we were unable to achieve sub-genomic RNA replication in PKR knockout primary hepatocytes. Knockdown of NCoA6 and PKR in Huh7.5 cells did not substantially impact sub-genomic replication, leading us to conclude that there are additional factors within the cell lines that affect their permissiveness for HCV replication such as epigenetic regulation during passage or transformation and immortalization. We also added miR-122 to Hep3B cells, a human hepatoma cell line lacking expression of miR-122 and previously thought to be non-permissive to HCV replication. Added miR-122 rendered the cells as highly permissive to HCV replication as the Huh7-derived cell lines commonly used to study the virus. In these cells, we were also able to observe miR-122-independent replication of sub-genomic HCV RNA. This was verified by use of a miR-122 antagonist that had no impact on the putative miR-122-independent replication, and by mutating the miR-122 binding sites to make them dependent on a single nucleotide-substituted microRNA. This replication in the absence of miR-122 was not detected in full-length HCV RNA, but was detectable using a bi-cistronic full-length genomic replicon, suggesting that the addition of a second IRES in sub-genomic and full-genomic replicons altered replication dynamics enough to allow detectable RNA replication without miR-122 binding. Because miR-122 has been implicated in protecting the viral RNA from destabilization and degradation by Xrn1, the main cytoplasmic 5´ to 3´ RNA exonuclease, we employed our miR-122-independent system to test this miR-122-mediated protection. We verified that miR-122 functions to protect the viral RNA from Xrn1, but this was insufficient to account for the overall impact of miR-122 on replication, meaning that miR-122 has further functions in the virus’ life cycle. We showed that the effect of miR-122 on translation is due to stabilization of the RNA by protecting it from Xrn1, through binding at both sites. We further evaluated the role of each miR-122 binding site (S1 and S2) in the virus life cycle, and found that binding at each site contributes equally to increasing viral RNA replication, while binding at both sites exerts a co-operative effect. Finally, we determined that binding of miR-122 at site S2 is more important for protection from Xrn1, suggesting that miR-122 binding at S1 is more important for the additional functions of miR-122 in enhancing HCV RNA accumulation. Altogether, we have shown that miR-122 is partially responsible for the hepatotropic nature of Hepatitis C virus, and that supplementation with this microRNA can render non-permissive cells permissive to viral replication. We have also identified and confirmed replication of both sub-genomic and full-length HCV RNA in the absence of miR-122. Finally, we have characterized the impact of the host RNA exonuclease Xrn1 on the HCV life cycle, and determined the roles of each miR-122 binding site in shielding the viral RNA from this host restriction factor.

Glomerulonephritis as an extra hepatic manifestation of chronic HBV infection has now been well documented [1,2,3,4,5]. HBV-associated nephropathy has been described in areas of both high and low endemicity [6]. In Africa HBV-associated nephropathy has been reported from the southern, central and northern regions [7,8,9,10,11]. In the southern African continent the prevalence of HBV-associated nephropathy appears to be higher than the rest of the continent [12]. In KwaZulu/Natal, South Africa, the prevalence of hepatitis B surface antigenaemia (HbsAg) in urban, rural and institutionalised children was reported to be 6.3%, 18.5% and 35.4% and the HBV exposure rates, as shown by the presence of any marker of HBV infection, 19.5%, 65.1% and 70.1% respectively amongst black children [13]. Prior experience of nephrotic syndrome (NS) and its association with HBV in black children, already published in a series of reports, showed HBV-associated nephropathy to be the commonest form of nephrotic syndrome among black patients in KwaZulu/Natal; membranous nephropathy (MN) being the commonest histological type reported [7,14]. The only other large series of HBV-associated nephropathy in southern Africa was from Cape Town of a large cohort of children, mainly of mixed ancestory (coloured), with a small number of black children [8]. There have been no other large studies of this condition amongst black children in Africa. We therefore undertook a series of studies to delineate the spectrum of this disease in black children with regard to the following: clinical presentation, laboratory findings, natural history, biosocial background, genetics (using HLA Class I and II antigens) as well as the impact of treatment and prevention by immunisation. We commenced these studies by reviewing our 20-year experience of 636 children with NS in Durban, South Africa for the period 1976- - 1995. Three hundred and six (48.2%) were blacks, 307 (48.2%) Indians and 23 (3.6%) were a mixed group (coloured); 91 (14.3%) could not be categorised and were excluded from the analysis. In black children, membranous nephropathy accounted for 43% of all cases of NS; 86.2% of these 306 children were associated with hepatitis B virus antigens [15]. This contrasts with the 2% - 5% prevalence of idiopathic membranous nephropathy reported in western countries [16]. We then proceeded to document the clinical features of this disease in black children. One hundred and thirty-three children with NS positive for HBV carriage were studied. In 70 patients the histological type was membranous; 46 of these 70 patients were followed up for a mean of 3.4 years (range 1-11). Spontaneous elimination of both HBsAg and HBeAg occurred in 10 (21.7%) of the 46 patients; 16 (34.8%) cleared HBeAg alone. Co-existing liver disease occurred in 18 (25.7%); hypocomplementaemia (low C3 and C4) in 22 (47.8%) and 5 (10.9%) of these 46 children respectively. Sixty-five (92.9%) of the 70 patients had normal renal function; 1(1.4%) impaired renal function; 3 (4.3%) chronic renal insufficiency and 1(1.4%) end stage renal disease at last hospital visit. Twelve (17.1%) of the 70 patients were in remission; all having cleared HBeAg. HBVMN was clinically indistinguishable from 24 children with idiopathic MN although biochemical characteristics were different. There were 23 patients with histological lesions other than MN. Forty patients with clinical, biochemical and serological findings similar to those with HBVMN and the other histological types, were unbiopsied. This report delineates the natural history of HBV infection in black South African children with NS, the majority of whom have MN. Disease remission in HBVMN parallels elimination of HBV antigens, particularly HBeAg. Comparison of HBVMN with idiopathic MN revealed clinically indistinguishable characteristics but unexplained biochemical differences [14]. Little is understood of the biosocial context in which HBV-associated nephropathy (particularly MN) develops. In the next two studies we evaluated HBV status and proteinuria in family members and household contacts of index children with HBVMN to test the hypothesis that HBV carriage and asymptomatic proteinuria are closely linked and may be causally associated. In the first of these two studies, thirty-one black children with biopsy-proven HBVMN were the index cases. One hundred and fifty-two family members and 43 black household contacts were the subjects of this study. We assessed HBV carrier status by testing for HBV antigens and antibodies using enzyme-linked immunosorbent assays (ELISA) and for HBV DNA by using slot-blot hybridisation and nested polymerase chain reaction. Sequencing of the precore HBV region of HBV was done in a subset of both index cases and subjects. Proteinuria was assessed by measuring the urinary protein: creatinine ratio. Seventy-two (37%) of the 197 family members and household contacts were HBV carriers, and 53 (27%) had a protein: creatinine ratio greater than the physiological limit (protein: creatinine ratio <0.2). Abnormal proteinuria was defined by a protein: creatinine ratio 0.2. Continuous data was compared using analysis of variance. Categorical data were compared using Chi-square test or Fisher’s exact test where appropriate. A probability of <0.05 was considered significant. The frequency of abnormal proteinuria was not significantly different in those with [22 (30.5%) of 72] or without [33 (32%) of 104] HBV carriage. This lack of association remained when carriers were classified into those who were HBsAg positive only and those with active viral replication (HBsAg and/or HBeAg and/or HBV DNA; p = 0.01). Family members were more predisposed to HBV carriage than household contacts, but abnormal proteinuria was present with equal frequency (p = 0.48). Age had a significant impact on proteinuria, with children less than five years being more likely to have abnormal proteinuria (p = 0.008). The prevalence of abnormal proteinuria in family members and household contacts of the index cases was more than in community-based controls. The 10 index HBVMN cases and 14 family members and household contacts that were tested all had HBV of genotype A. The results suggest that the family members and household contacts of children with HBVMN are at very high risk of HBV carriage; they also have asymptomatic proteinuria at a significantly higher rate than community-based controls. The HBV carrier status was not associated with proteinuria. This lack of association was a finding supported by peak prevalences of proteinuria in those under five years but no corresponding peak of HBV carriage. Proteinuria may indicate glomerular basement membrane dysfunction. Environmental and social factors may underpin development of these two disorders, but are insufficient to account for the index cases of HBVMN. The emergence of children with HBVMN from such households additionally depends on unidentified and possibly genetic factors [17]. In the second study of the biosocial background in which the HBV carrier-state with MN develops, we used the same subjects. One hundred and twenty-three unrelated individuals from the communities of the index cases, negative for HBV, served as controls. In this study, proteinuria was assessed using sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and protein: creatinine ratios. Patterns of proteinuria on SDS-PAGE were classified as glomerular, tubular or mixed; IgG and haptoglobulin were suggestive of MN. Seventy-two (36.9%) of the 195 family members and household contacts were HBV carriers; 21 (29.2%) of these carriers had evidence of proteinuria using SDS-PAGE. Twenty-eight (41.2%) of the sixty-eight members of the study group who were HBV negative and 26.8% of the controls also showed proteinuria on SDS-PAGE. This lack of association between HBV carriage and proteinuria remained when controlled for gender and family relationship. Also, HBV was not protective against the development of proteinuria. Age was associated directly with a glomerular pattern of proteinuria (p = 0.007). Those having a pattern of proteinuria suggestive of MN were more likely to have an abnormal protein: creatinine ratio (p = 0.001). Ten (59%) subjects with a membranous pattern of proteinuria and 19 (47.5%) with a non-membranous pattern of proteinuria had microscopic haematuria. Such a pattern of proteinuria was not significantly different between subjects and community based controls (8.7% vs. 6.5%, p = 0.5). Environmental exposures in these subjects may be responsible for the proteinuria, which probably reflects underlying glomerular basement membrane damage. Discordance between the HBV carrier-state and patterns of proteinuria in the study group suggest that interaction between specifically vulnerable individuals and HBV group suggest HBV and MN may not be causally related or that it reflects exceptional interaction between specifically vulnerable individuals and HBV [18]. From the above two studies we inferred that the pathogenetic mechanisms by which individuals with chronic HBV infection develop MN are probably dependent on interactions between viral, host and environmental factors; some evidence suggests a genetic predisposition. We therefore undertook another two studies to explore HLA associations in black children with HBVMN. In the first of these two studies, thirty black children, age range 2 to 16 years, with biospy-proven HBVMN, were the subjects of this study. HLA A, B and C antigens were determined using a two-stage lymphocytotoxic test. HLA DRB1* and DQB1* typing was done using sequence-specific primers. HLA class I and II antigen frequencies of the study subjects were compared to controls that were randomly chosen healthy blood donors from the same population. HLA DQB1*0603 was increased in patients with HBVMN compared to controls (chi-square 13.65, RR 4.3). DRB1*07 and DQB1*02 were increased in frequency in the study subjects but failed to reach statistical significance. There was no significant difference in the frequencies of class I antigens in the study group compared to controls. This study is the first report of HLA associations in black patients with HBVMN in whom Class I and II antigens were determined using molecular methodology. It shows a high frequency of DQB1*0603 in black children with HBVMN compared to controls suggesting a possible genetic predisposition to the development of HBVMN [19]. Following our findings of an HLA Class II association in black children with HBVMN, we proceeded to determine if HLA DQB1*0603 predisposes to HBV carriage and development of abnormal proteinuria in the second study. We studied 70 family members of 14 children with HBVMN positive for HLA DQB1*0603 selected from the first study. Associations of HLA DQB1*0603 to HBV carriage and abnormal proteinuria were determined using the mean probability ratio (LOD scores). Forty-seven of the 70 (67%) family members were positive for HBV infection. Nineteen (27%) had abnormal range proteinuria. LOD scores in the study subjects with DQB1*0603 who were HBV negative vs. those with DQB1*0603 who were HBV positive was not significant (anti-log sum = 2.0559 and average 0.23). When a similar calculation was done for abnormal proteinuria, there were no significant findings (anti-log sum = 3.8587 and average 0.43). This lack of association between HLA DQB1*0603 with either HBV carriage or abnormal proteinuria in family members suggests that additional factors may play a role in predisposing children to chronic HBV carriage and the development of MN. We therefore conclude that the main effect of HLA DQB1*0603 which distinguishes HBVMN from family members is the degree of proteinuria which is a reflection of the severity of glomerular basement membrane damage in the latter [20]. In the next study we proceed to investigate the efficacy of Interferon alpha 2b (INTRON A ®) in the treatment of HBV-associated nephropathy in black children. Twenty-four black children with biopsy-proven HBV-associated nephropathy were recruited into the study during the period April 1997 to June 1999. Five defaulted treatment and were excluded from the primary analysis. IFN 2b was administered for 16 weeks. Response to treatment was defined as loss of HBeAg, decrease in proteinuria, and prevention of deterioration in renal and liver function. A control group of 20 patients was followed up for the same period. Ten (52.6%) of the treated children responded with clearance of HBeAg by 40 weeks. None cleared HBsAg. All responders showed remission of proteinuria, 90% maintained normal renal function and 1 (10%) showed improvement of renal function. HBV DNA levels decreased in this group. Nine patients did not clear HBeAg; none showed remission of proteinuria, 2 showed deterioration of renal function. Liver enzymes rose during treatment but subsequently declined irrespective of response to therapy. No serious side effects were encountered. Only 5% of controls showed spontaneous clearance of HBeAg, and none had remission of proteinuria. Black children with HBV-associated nephropathy show accelerated clearance of HBeAg with remission of proteinuria following treatment with IFN 2b. IFN 2b was well-tolerated [21]. We then went on to investigate the impact of HBV vaccination in South Africa over 6 years on HBV-associated MN. HBV vaccine has resulted in a decline in the incidence of HBV carriage and hepatocellular carcinoma in South East Asia. Vaccine efficacy in Africa has not been adequately assessed. King Edward VIII Hospital, Durban, South Africa, is the only tertiary referral centre for the province of KwaZulu/Natal for children with renal diseases. HBV vaccine was introduced into the Extended Programme on Immunisation (EPI) in April 1995; vaccine coverage rates between 1995-2001 for children for the first, second and third doses were 85.4%, 78.2% and 62.0% respectively. HBV status was determined using radioimmunoassay (1984 – 1991) or ELISA. MN was confirmed on renal biopsy. The hospital average annual incidence of HBVMN was compared pre and post-vaccination, and according to age groups. Between 1984 and 2001 there were 119 children with HBVMN; the mean age was 7 years (range 1 to 14 years) and 101(85%) were males. The average annual rate ratio (aRR) per 105 child population was 0.25. The aRR of 0.03 for the years 2000-2001, was significantly lower than the aRR of 0.22 during the pre-immunisation period (1984 – 1994) [p = 0.003; RR = 0.12 (95% CI: 0.03 – 0.5)]. The aRR in 2000-2001 for children 0 – 4 years (0.00) and 5 – 10 years (0.09) were significantly lower than in the pre-vaccination years (0.16 and 0.46, p = 0.01 and 0.02 respectively). Thus, HBV vaccine, even at low coverage for the full EPI schedule, reduced the hospital incidence of HBVMN by six years [22]. From this series of studies we concluded that prior to the introduction of the HBV vaccine into the Expanded Programme on Immunisation in Children, HBV-associated nephropathy, particularly MN was the commonest form of NS in black children. Several studies have suggested on the basis of epidemiological, clinical and immunological evidence a causal association between chronic HBV carriage and the development of nephropathy. In our present series of studies we have findings that lend further support to the causal association between HBV carriage and development of nephropathy, particularly MN, in black children. We have shown that genetic and other environmental factors may also play a role in determining the degree of proteinuria. Those children with abnormal range proteinuria less than the nephrotic range show no association with HBV carriage or genetic factors with regard to HLA linkage. The efficacy of interferon treatment in elimination of the HBV and abrogation of proteinuria following clearance of the virus (particularly the HBeAg) as well as the impact of routine HBV immunisation in preventing HBV carriage and subsequent development of nephropathy lends further support to our findings. The impact of viral load has yet to be investigated. / Thesis (Ph.D.)-University of Natal, Durban, 2002.

Ulm, Univ., Diss., 2008.